Messy Methodological Musings:
Engaging in “Successful” Qualitative
Health Research
AlAnA ferguson &
roAnne thomAs-mAcleAn
Introduction
In this article, we trace our experiences with engaging in “messy” research processes.[1] Too often, research methods courses and graduate work depict research as a straightfor-ward, linear, and tidy process. Coursework and preparation for research tends to follow a pattern of question or topic generation, proposal, ethics approval, data collection and a production of findings, which usually consists of a manu-script outlining the same process. Following these proce-dures, research is deemed “successful.”
The literature identifies participatory action research as a process whereby the outcomes are directed by the participants.[2] Certainly, it has been acknowledged that participatory methodologies produce unexpected findings, yet rarely do publications depict the true “messiness” of that process; there is usually a tidying up of the findings, with only an allusion to the fact that participants directed the pro-cess. There is little mention of the uncertainty researchers might encounter when doing participatory action research. Further, when graduate work is tied to participatory action research, the general academic expectation remains -- to generate a traditional thesis based on the proposed out-comes which are approved by a committee and an external examiner.
Here, we share our experiences in research which would not traditionally be deemed successful. The proposal outcomes did not enfold, the thesis took a dramatic new course, and the mentoring for unanticipated outcomes was necessary. As such, we, a graduate student and a supervisor, challenge the notion of success as accomplishing specifically what we
1
Abstract
Participatory research projects incorporating non-traditional, creative, and qualitative methodologies can
produce results which are unexpected or divergent from original research proposals. These results are highly
meaningful, yet challenging to express to an audience when the expectation is to write the findings in a linear
and traditional format, such as in a graduate thesis. Within this article, we use an autoethnographic approach
to describe our experiences with ethnodrama, from our perspectives as a graduate student and supervisor. We
focus on a planned breast cancer ethnodrama pilot project, which developed into a healing yoga program
instead. We question the traditional notion of successful research as being a linear, straightforward process.
In doing so, we hope to create dialogue and support mentorship which acknowledges the “messiness” of
research projects. We also assert that there is a need to embrace non-traditional methods for disseminating
our “messy” research outcomes.
propose in our research programs. Further, we challenge the need to write up our findings in a traditional graduate thesis. A graduate thesis usually is considered a successfully com-pleted aim, when research follows and is written in a typical pattern of introduction, review of the literature, discussion of methods and interpretation. When projects veer in differ-ent paths, yet still produce prosperous outcomes, might such research still be considered successful?
Our experiences, as a graduate student and supervisor, do not match traditional teachings and learnings of a linear, goal oriented research process. That is, we did not follow a straight line from project inception to completion. However, the learning outcomes were vast. While we did glean important “findings” from our work, it also illuminates ideas about the research process, particularly participatory action research and the learning potential for auto-ethnography in health research. Inspired by the work of Ron Pelias, Laurel Richardson and Carolyn Ellis, our work shows that embracing our own experiences and our own participatory journey in the research process can be as equally engaging as the outcomes themselves.[3-5] Moreover, having engaged with feminist research, we find ourselves in a place similar to Richardson’s[6] – we struggle with writing in “science’s omniscient ‘voice from nowhere’” – and therefore present our writing in a non-traditional format, while sharing findings and experiences from a qualitative project that would not be traditionally defined as “successful”.[p3]
Context, methods, and research questions
This paper shares learnings from a pilot project which began in November 2007. In the context of this work, we planned to use ethnodrama as an innovative qualitative method to explore lived experiences of breast cancer survivors. The goal was to collaborate with women in order to dramatically share their experiences with community members and healthcare professionals to promote awareness of disability after breast cancer. Optimistically, we also hoped to influence some degree of social change, perhaps improved health or self-care.
At the time we began our pilot project, disability after breast cancer had not been previously studied in Saskatchewan. As researchers, we thought ethnodrama would be an innovative and meaningful way to document and present women’s experiences to healthcare professionals and community members here.
However, through the participatory action process of this project, our work resulted in a yoga program instead of an ethnodrama – not at all what we had planned. Originally, the dramatist included a yoga teacher to work with the women as an ice breaker and a way to prepare their breath and bodies for theatre. Participants’ stories of health and illness emphasized a need for a healing yoga program, rather than a theatrical performance. Thus, our work was reshaped and the methodology was altered. A diagram mapping the meth-odological and outcome changes is outlined.
Initial project discussions & interview with possible dramatist:
To discuss the process of creating an ethnodrama from existing data charting the course of arm morbidity after breast cancer
Ethnodrama workshops begin:
Theatrically exploring experiences of arm problems after breast cancer with survivors, a dramatist, and a yoga teacher Participants express their healing and positive experiences with
the yoga component
Interviews:
With researchers, the dramatist, and yoga teacher involved in the ethnodrama with breast cancer survivors
Healing yoga classes begin:
A Gentle Yoga Class Focusing on the Gift of Breath for Breast Cancer Healing
Roanne’s work around arm problems after breast cancer evolved from exploring embodiment and cancer through theatre, to explorations of embodiment and yoga after cancer. Alana’s thesis was seeking to use phenomenology to uncover meanings out of the lived experiences of researchers and participants in the arm morbidity ethnodrama. Given that an ethnodrama did not take shape, instead interviews were conducted with researchers, including Roanne, whom had experience with ethnodrama projects (successful or not, cancer related or not). Some of the key interview questions were as follows: How do you define ethnodrama, what does it mean to you?; What are some of your reasons for choosing to use drama as method of health research dissemination?; Could you speak about some of your specific experiences with ethnodrama creation?; Compared to other types of research projects that have you been involved with, how is ethnodrama research similar or different?; What are some of the aspects that stand out to you as positive in ethnodrama projects?; What are some of the aspects that stand out as challenging or what were some of the challenges that you personally faced in ethnodrama projects?; and Has ethno-drama affected your life and/or career?
The process of the “ethnodrama” workshops with the women who chose a yoga program was also captured through field notes and written in the findings section of the thesis. It was an eclectic approach, yet gleaned exciting findings. Alana reflected on her own experience with ethnodrama and her own experience with untraditional thesis findings in two autoethnography chapters. In this article, we both use auto-ethnography to further document our experience with this untraditional, participatory research program.
Below, we briefly contextualize our work within three methodological areas: participatory action research; ethno-drama; and autoethnography. We refer to participatory action research related to health research in a broad, overarching sense. We accept that a variety of disciplines or professions use participatory action research and feel that this article would speak to a variety of research experiences. All three of these paradigms provide the background for our meth-odological musings about our messy research project, and its place in a graduate program.
Support from the literature
1. Participatory action research
Participatory action research occurs when: “participants in the process own the inquiry. They are involved authentically in making major focus and design decisions. They draw and
apply conclusions. Participation is real, not token.”[7 p185] These guidelines are especially important to our work because the messiness of the research process was very much connected to the participatory aspects of our project. Ramsden and Cave[8] note that participatory research involves a “letting go of one’s own power” as a researcher, or “sharing the power that one already has”.[p548] In other words, there is an emphasis upon equality between participants and researchers, and participants have some degree of control over the research process.[9 p1671] While literature on participatory research emphasizes its positive aspects (e.g., building long-term relationships with commu-nities), few researchers have explored the impact of partici-patory research on their identities and their work.
Mitchell, Jonas-Simson, and Ivonoffski[10] briefly touch upon the experiences of researchers who have documented their changed identity while producing their participatory research theatre: “I’m Still Here.” Mitchell et al.[10] speak to the life-changing moments emerging from participatory research, although not intricately. From their work, however, we do begin to understand how the researcher and the “researched” share the research process.
Their participatory action research with drama adds another layer of complexity to research processes, with an emphasis upon the growing interest in creative methods of data ga-thering and interpretation, as well as the blurring of disci-plinary boundaries between the humanities and the social sciences. Creative, participatory action research methods, such as photovoice and ethnodrama, seem to genuinely pro-mote participant ownership of the research process, while working toward social change (e.g., Wang[2]). For instance, participatory autoethnography or ethnodrama seek to ensure that the performance, monologue, story, poetry, or diary comes directly from the participants’ lived cultural and social experiences, but that they also include reflection from the researcher(s). In some cases, the lines between researcher and participant become blurred; a participant in the play may be a researcher as well (see Gray et al.[11], Lobel[12]). Non-traditional and creative qualitative methodologies, such as those which combine research with drama, poetry, pho-tography, or any creative channel are innovative. Creativity allows for participants to artfully engage, share their exp-erience, and practically connect with the research process. These are methods, often messy, which allow participants to own the process through malleable and genuine techniques, arguably in ways that traditional, scientific research methods cannot.[13-4]
2. Ethnodrama or participatory research theatre
Researchers are increasingly embracing methods which merge their research with artistic techniques (see Foster[15], Madill[16], Mienczakowski[17], Wang[2], Watson[18]). Creative, artistic, and sensually stimulating representations of research have the potential to authentically engage partici-pants and reach audiences in numerous, compelling ways. For instance, projects which synthesize research and art have been shown to: bring about in-depth personal reflection;[16] enhance the ability to create meaning in our lives;[19] accomplish a heightened awareness of social issues;[20] and promote social change[21].
Ethnodrama, or participatory research theatre, is a relatively new qualitative methodology. Ethnodrama may be consid-ered both a qualitative method and a knowledge dissemina-tion tool, where research findings, or participant experiences, become dramatically and artfully displayed to an audience. Enacting research moves away from traditional text reports and has the potential for audiences and participants to make a deeper connection with the findings.[13] Ethnodramas encompass a range of forms, such as one person plays,[12] professionally performed scripts,[22] readers’ theatre,[23] participatory theatre,[13] and community theatre.[20,24] Another example is participatory research theatre which is similar to the ethnodrama project outlined in this article. Denzin[21] explains that the meanings of lived experiences become apparent in these performances, regardless of the shape or form. Each lived experience is powerfully conveyed to an audience, researcher, and/or participant in a way that has potential for social change. This method has been utilized for projects on Alzheimer’s disease,[25,10] AIDS and HIV,[26] Informal Caregivers[13] and has already been used in contexts of cancer (e.g. Lobel[12]) and, more specifically, breast cancer[11].
Despite its increasing popularity, researchers’ experiences with ethnodrama are not well documented. Gray et al.[11] emphasize that: “As this new field of research-based theatre continues to grow it will be important for more researchers to detail the process they go through, including their many (inevitable) mistakes and dilemmas as well as their resolu-tions”.[p143] Additionally, Denzin[21] demonstrates that lived experiences and narratives come through perfor-mances, but the lived experiences that happen behind the scenes in the process are not as well documented. These are the learnings that we may miss in classes and workshops on research design. These learnings reflect non-linear, cre-ative, and non-traditional research outcomes. There is also a
corresponding need for further exploration of the intersections between participatory research and art. Although some work is being done in this area (see, for example, Leavy[27]), documentation of researchers’ experiences is still scant, as are first person accounts of the challenges of participatory research, such as ours.
We convey our experiences behind the scenes of our ethno-drama pilot project through our experiments with auto-ethnography[5], the third domain of literature we examine before turning to reflections upon our work.
3. Autoethnography
Patton[7] defines autoethnography with a foundational question: “How does my own experience of this culture connect with and offer insights about this culture, situation, event/or way of life?”[p84] Trotter, Brogatzki, Duggan, Foster, and Levie[28] illustrate that our own voices, as researchers, are significant and create authenticity in our work. Research-ers are utilizing autoethnography to explain social experi-ences from their own lived perspective, but also through the use of the sociological paradigm to critically engage with those experiences. For example, Kolkner (cited in[29]) is a researcher who wanted to move beyond “recording and analyzing the lives and worlds of our “‘subjects’”, to tell her “story, informed by the tools and conceptual frameworks of sociology”.[p134-5]
Carolyn Ellis’ work is at the forefront of the autoethnographic movement. She describes her role as an autoethnographer:
I am both the author and focus of the story, the one who tells and the one who experiences, the observer and the observed, the creator and the created. I am the person at the intersection of the personal and the cultural…”[5 p13]
An example of Ellis’s work, demonstrating her role as an autoethnographer, is a piece based on her experiences with the trauma of September 11th, 2001. Ellis[30] describes this process as “turning something chaotic into something pot-entially meaningful” (p. 375). A key reason for taking on the role of autoethnographer is to make meaning out of complex situations. As such, the more we discover about our experi-ences and reflect on our own social lives, the greater the prospect for societal and personal change.[31]
Another reason for writing an autoethnography is to reach clearer understandings of emotionally charged topics. Ellis and Bochner[29] speak to this noting that we can praise emotional connectivity to social sciences research and within autoethnographies, rather than viewing emotional response as a weakness. Such connectivity is a rare occurrence in
health research and within social sciences literature, even though these connections are often necessary for lived, per-sonal, or societal changes. In the next section of this article, we embrace autoethnographic writing to connect our voices, experiences, and emotions, in an attempt to make meaning out of messy research.
Reflecting on our messy project – success?
The methodological areas which we discussed above are relatively new and involve considerable change to the ways in which research might occur, yet the vision of the research process has not changed significantly in recent decades. Our traditional teachings and learnings about research do not reflect the complexity, emotionally engaged, and participant-led aspects of these methodologies, nor do most published accounts of research reflect the messiness inherent to new methods. We turn now to an exploration of our experiences of the research process, which were enhanced by our will-ingness to work in non-traditional ways. Even though we dis-cuss separately our understanding of the aspects of our messy research endeavour, they overlap and are interconnected. First, we discuss the process of the research as it shifted, through the lens of the principal investigator of the pilot project (Roanne). Second, Alana conveys her experiences as viewed through the lens of the student researcher connected to this study. Our findings are not reflective of our original research design. However, upon reflection we understand them to be quite successful.
From Roanne
Alana was a student in one of my qualitative methods courses and was struggling to find a thesis topic that would be mean-ingful to her. From my point of view, meanmean-ingful meant that she wanted to work on a project that had some potential to affect people’s lives in a positive way. At that time, I was also starting to think about innovative ways to share findings from one of my projects on disability after breast cancer. Together, with another researcher, Alana and I discussed the idea of her shadowing the creation of an ethnodrama related to that project. Early on, it became clear that the project was not proceeding as planned, and that Alana, was not going to have an ethnodrama to discuss in her thesis. For example, we had difficulty finding a script writer. It seemed the eth-nodrama could proceed, but not in a reasonable timeframe for Alana to complete her program. I was very conscious of academic timelines – “time in program” is a frequently discussed issue at my institution and is tied to the funding formula for graduate students. So, I suggested Alana
inter-view me and other researchers involved with ethnodrama in order to provide her with some “data” to interpret, assuming we would not be able to document the ethnodrama process in its entirety. Alana recorded our interview and transcribed it verbatim. What appears below is my attempt to evoke my “academic and daily life” as I assumed the dual role of research participant.[4]
I will never forget my first “live” exposure to ethno-drama. I was attending a conference and in lieu of a more conventional keynote, we watched a perfor-mance of Brian Lobel’s Ball which conveys his experi-ences with testicular cancer. I did not expect to be emotionally connected to a keynote at a conference and surreptitiously watched my colleagues to see how they were reacting. Lobel received a standing ovation. I shared this experience with Alana:
All of the paper sessions were more conventional pre-sentations, [and they] started almost a half hour late because nobody wanted to leave [the ethnodrama] and they all had lots of questions. He [the performer] received a standing ovation…And it’s weird too because you’re processing things on a personal level and on an emotional level and everything else but, I remember a lot of what he said would resonate with what I’d been writing and trying to uncover in my own work, you know that cancer isn’t just about this heroic journey and we can’t all be Lance Armstrong, but I also remember being very uncomfortable, I think in the, it’s right at the beginning where he talks about, he was masturbating when he found his lump so, it made me uncomfortable. I guess to use a cliché, it’s just a roller coaster of emotions to see that performance.
Lobel’s performance [12], along with my readings of ethnodrama (e.g., Gray et al.,[11]) made me want to work with this method. From my orientation to ethnodrama, my interview with Alana then moved to my experiences with the project with women facing disability after breast cancer. I began by sharing my concerns about working with script writers:
I guess it was hard to know what to expect from the script writers and we worked with more than one. I didn’t really have a sense of what they would do or not do, but when I would approach other researchers about something else, I would know the questions to ask, like: Are you prepared to fulfill this role? If I was working with a statistician, I would ask: How much of the analysis are you gonna do? But um, I didn’t
know what to do with the dramatists. So I was very uncomfortable with that.
I then talked about the difficulties of working within a research budget and determining what to pay the dramatist:
Maybe because it’s art, it seems like it shouldn’t be linked to commerce and payment. So, you know, my statistician would tell me for example, I charge this much per hour. I wasn’t sure how to negotiate that with a script writer, or even what they would do, and then our first script writer came up with so many ideas which was great but then it was hard to figure out exactly what we should do. And I guess in hindsight we probably should have had women with breast cancer right there from the start. So if I had to do something differently that probably would have been it. But then again, it was hard enough try-ing to negotiate what the script writers role would be, I don’t know if then other people were there if that would make it more difficult or not.
As we progressed through the interview, I highlighted my concerns about the changing nature of the proj-ect, as the dramatist and yoga instructor were hesi-tant about encouraging the women to produce our “outcome” – the ethnodrama – and focused more on discussion and yoga:
It was about trying to figure out how much to push and what to push for and when to step back and say “Okay, just let this go”, or “Maybe that has to be that way.” But also trying to gather some data was chal-lenging, how do you do this when, it has to be intui-tive and a process coming out of empathy? And then, how do you also ensure that you meet the demands of a graduate program that is happening?
I also raised questions about the nature of academic work and the resulting tension between productivity and participatory research:
That is the pressure -- to secure funding and publish results. But, there isn’t really any acknowledgment of building partnerships, so I think probably ethnodrama would face some of the same challenges as community based research where you don’t want to do helicopter research and just drop in, but how do you find the time and financial support to build the relationships that you need to build over the long term?
As we reached the end of our interview, I concluded:
I think that’s also something that we need to do as researchers, is document all of these things [lived experiences of ethnodrama] so they don’t get lost… Not just in anything associated with art, but in all projects. What are the different realities? I think it’s important to document the process as it is. Or, it’s as important to document the process, if not more so, than it is to document the outcomes or the findings.
From Alana
When I began my Master’s program, working with Roanne, to produce an ethnodrama on women’s experiences of arm problems after breast cancer, I knew the process would be challenging and accom-panied with many learning moments. However, I did not anticipate our aim of an ethnodrama production, would not result. I did feel as though I had failed. I asked myself questions, such as: What if we had, as
the dramatist later suggested, incorporated a drama therapist? A therapist who would be able to work on inner healing, before presenting experiences to an audience? What if we had not used yoga, but rather more exuberant theatre exercises? What could I have done differently to promote the theatre components?
As Roanne’s words reveal, we can learn from the challenges with the non-linear from those who have also experienced these “unsuccessful moments.” While interviewing Roanne, I discussed my concerns. She explained to me that the word research can be traced back to its linguistic roots which mean to move
in a circle. Roanne offered me mentorship and
sup-port in how to follow the non-linear which emerges with the non-traditional methodological forms we were embracing. We spoke about how this project represented a circular process of discovery and that we should not discount the process of research; it can be as influential as the findings or conclusions themselves. Each part of the research circle is equally significant.
Maybe the intended purpose of our workshops was not reached, but the discoveries made within the ethnodrama process lend themselves to successful outcomes. These include learning the importance of inner healing after illness and the benefit of yoga for starting a healing journey. We attained knowledge that might not have emerged otherwise. This attain-ment represents success.
Some questions I ask myself now are: What if the
yoga teacher had not been so wonderfully involved and willing to create a program for breast cancer sur-vivors after the workshops? What if we had not had a dramatist who was so gentle and willing to move with the women’s desires? What if we had not had the remarkable and stunning women come to the work-shops and share their lives with us? What if Roanne had not been so comfortable with non-traditional and participatory based research methodologies? If not for
these four elements, the prevailing discoveries and the end result of a healing yoga program would not have been actualized.
These components made this research successful on a number of levels. For instance, the dramatist has pro-vided valuable insights to this process and has offered guidance for future work in this area; particularly the suggestion of a drama therapist to be included when working with theatre and illness experiences. Roanne was compassionate and willing to shift the ethnodrama project in a new direction, this certainly attributed to the success. And, it was especially help-ful that the yoga teacher was incredibly willing to devote her teaching time to this group.
The yoga program filled to maximum room capacity soon after advertised throughout the city, demon-strating a need and desire for yoga, as connected to healing after breast cancer. A successful outcome is that this research is now being pursued; Roanne and a research team have begun explorations of connect-ing yoga to their national arm morbidity research project.
The yoga program began to serve breast cancer sur-vivors only, but then expanded to become a gentle healing class for the public. It still continues and is helping women and men heal their minds and bodies. The dramatist described this process as healthy seeds being planted into rich soil. Successful outcomes have been growing from this process. After attending one of the healing yoga sessions, I saw how joyful the women were with the classes. I slowly let out a breath of relief and thought to myself: Success.
I recently attended a seminar where I learned that “sem”, as in dissemination, is linguistically connected back to the word seed. Participatory action research may be like a seed: we disseminate, plant, or throw ideas into the wind, but we do not always have
con-trol over the outcome. The radiant part about partici-patory action research is that it allows the participants to choose the seed, where it gets planted, and how it grows (if at all). Certainly I feel this is something I was able to learn, with mentorship from Roanne. This was a moving and meaningful discovery to make together.
We continue to reflect
The construction of the research process as a linear one is undeniably artificial. Yet, there are many persuasive reasons to continue to perpetuate this conceptualization, not the least of which are the realities of graduate programs and timelines. However, clinging to this conception of research as linear may limit experience and the sharing of findings. This is a hin-dering factor, even as researchers attempt to create positive environments in which students may thrive and may begin to reflect upon the complexities of health research in prepara-tion to become “independent researchers.” Based upon our experiences, we assert that research methods courses and graduate student mentorship should expand to recognize the potential of learning that would not be defined as successful from a traditional point of view espousing research as linear. Indeed, as identified in Aporia, methods of dissemination have to become more accessible to the public, and further enhanced with community participation. Our experience with drama reflects the need to extend research into the community, and particularly with a non-textual medium. We find ourselves in a paradoxical situation of sharing our experiences in a fairly traditional format (writing for a journal), although the structure of this article differs slightly from what is typical. Perhaps, with new media such as You-Tube and Facebook groups, a variety of illness experiences will be depicted through accessible and visual methods of knowledge sharing. Given students’ interests in media, visu-ality, photography, dance, theatre, or possibly even yoga, the exploration of innovative and creative methods of dis-semination would be timely. As we need to accept that our research findings may not emerge in a linear way, we should simultaneously explore creative, non-traditional methods of presenting those findings. This exploration would promise to make the research endeavour messier, but richer and hence “successful.”
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Acknowledgements:
We would like to acknowledge that the pilot ethnodrama project was supported by a New Investigator Award, Canadian Institutes of Health Research (CIHR)/Saskatchewan Health Research Foundation (SHRF). We would also like to sincerely thank every-one who provided guidance, support, participation, or research assistance for this project. Particularly, we would like to acknowl-edge the outstanding guidance and support of Drs. Elizabeth Quin-lan and Jennifer Poudrier, who served as committee members for this thesis. We would also like to thank Dr. Kent Kowalski who served as the external examiner, and whose questions/comments continue to encourage us to reflect on our work. Thank you also to Ms. Laurie Schimpf and Dr. Susan Robertson for their much valued research assistance.
Contact Information for Author: Alana Ferguson, MA
Health Research Facilitator
Office of the Associate VP Research-Health / VP Research & Innovation
University of Saskatchewan B526 Health Sciences Building 107 Wiggins Road
Saskatoon, Saskatchewan, S7N 5E5 Canada Email: alana.ferguson@usask.ca Roanne Thomas-MacLean, Ph.D. Associate Professor University of Saskatchewan Department of Sociology
